Predicting Coil Embolization in Patients with GI Bleeding with Hepatofugal Flow

Purpose To investigate whether main portal vein (MPV) hepatofugal flow (HF) prior to transjugular intrahepatic portosystemic shunt (TIPS) creation can predict post TIPS variceal embolization in patients with gastrointestinal (GI) bleeding.

Materials and Methods A retrospective review of consecutive patients with GI bleeding who underwent TIPS from January 2007 to January 2017 was conducted. Pre- and post-TIPS portosystemic pressure gradients and embolization of varices were reviewed. The directionality of the blood flow in the MPV prior to TIPS creation was determined to be HF or hepatopedal (HP) by a fellowship trained interventional radiologist blinded to the hypothesis. Variceal embolization data was analyzed using the Fisher’s exact test, and mean post-TIPS portosystemic pressure gradients were analyzed using the student’s t-test. A p-value <0.05 was considered statistically significant.

Results Forty patients were identified. The predominant causes of cirrhosis were alcohol abuse and hepatitis C infection. Twenty-four patients demonstrated HP flow, and 16 patients had HF flow. Of the 24 patients with HP flow, 25% required coil embolization post TIPS compared with the 62.5% in those with HF flow who underwent post-TIPS embolization, (p = 0.0245).

Conclusion In patients with GI bleeding, HF blood flow in the MPV prior to TIPS creation may predict post-TIPS variceal embolization requirement.

In this study, we have demonstrated an association between the presence of HF flow on pre-TIPS portograms and the probable need for coil embolization in TIPS procedure. Larger scale studies are required to validate the data, including prospective randomized trials.

No conflict of interest has been declared by the author(s).